Ch. 38 ortho trauma

the tibia supports how much of the upper bodys weight

90 percent

mallet finger (baseball fracture)

Occurs when a finger is jammed into an object, resulting in an avulsion fracture of the extensor tendon

RICE for sprains and strains

Rest, ICE, compression, elevation (raise the injured part just above the level of the patients heart to decrease swelling) splinting

vertical shear

from above or below, such as when a person falls from a significant height and lands on the feet, on landing the force is transmitted through the legs to the pelvis leading to complete displacement of one or both sides of the pelvis toward the head

with a midshaft humerus fracture if it is angulated

gentle longitudinal traction may be applied to correct the deformity; but efforts should be halted if the patients pain is too severe or if the patients neurovascular status worsens

if a long bone fracture is severely angulated

gently apply longitudinal traction to attempt to realign the bone into a more natural position and improve circulation

what is the exception to attempting to straighten fractured joints witihout first obtaining medical direction

if there is a loss of distal circulation or an extended transport time to the hospital

90% of hip dislocations involve

posterior dislocation majority occur due to delceleration injuries in which a flexed knee strikes an immobile object with a great degree of force

when bleeding or swelling occurs within a compartment for any reason the pressure within it rises

pressure that is too high may preven tblood flow in vessels supplying the muscles within the same fascial compartemtn

if the pt you are treating has an airway or breathing probem or significant bleeding then

provide rapid transport to the hospital for treatment and apply individual splints en route

late sign of compartment syndrome

pulselessness

circulating myoglobin results in what

renal vasoconstriction

one way to stabilize multiple fractures when the patients overall condition is critical is to use a

scoop stretcher

what is the first sign of compartment syndrome

searing or burning pain that is localized to the involved compartment and out of proportion to the injury

petechiae

small, pinpoint hemorrhages

Spiral fractue

spirals

simple methods for controlling pain include

splinting in an anatomic position, resting and elevating the injured part, and applying ice or heat packs

what is the partial dislocation of a joint called

subluxation

nursemaids elbow

subluxation of the radial head

elbow fractures (distal humerus)

supracondylar fractures of the humerus occur often in children

angulation of a fracture means

that each end of the fracture is not aligned in a straight line and that an angle has formed between them

if a person falls from a height and lands on their feet

the force of impact may be transferred up the legs resulting in pelvic fractures

with midshaft humerus fractures what nerve is a concern

the radial nerve which may be injured by the force itself of could become entrapped within the fracture sit

lateral compression

the side of the pelvis that sustains the impact becomes internally rotated around the sacrum and the actual volume within the pelvis decreases

if musculoskeletal injuries in the extremities are suspected

they must be at least initially stabilized if not splinted before moving the patient access for pms

for a hemodinamicly unstable pt dont waist time

traction splinting rather use vacuum mattress long board or scooop stretcher

compartement syndrome

two note cards above explain this

Devascularization

when blood vessels are damaged following a musculoskeletal injury, loss of blood flow can occur in the body part supplied by that vessel a

diastasis

when the ligaments that hold two bones in a fixed positioin with respect to each other are disrupted and the space between them increases

to help remember that a strain involves a tendon note that the word strain includes a

"T"

heat therapy should generally be avoided during the initial

48-72 hours because it may increase pain and swelling during this period

a person who sustains a FOOSH may have one or more injuries as the result of forces transmitted proximally from the point impact

1.) fracture of the scaphoid bone of the hand, 2.) fracture of the distal ulna and radius 3.) fracture dislocation of the elbow, 4.) fracture dislocation of the shoulder, or 5.) fracture of the clavicle

how many bones make up the skeleton

206

if possible splint the injured hand in the position of function by placing the wrist in about

30 degrees of extension with the fingers slightly flexed,

bones decrease in density after the age of

35

time frame for crush syndrome

4-6 hours after that muscle cells begin to die and release their contents into the localized vasculature

cold packs or ice are useful for treating patients during the initial

48 hours following an injury and effectively decrease pain and swelling

Osteoporosis

A condition in which the body's bones become weak and break easily.

straddle fracture

A fracture of the pelvis that results from landing on the perineal region.

pneumatic splints are not effective for

Angulated fractures or for fractures that involve a joint because they will forcefully attempt to straighten the fracture or joint.

6 Ps of musculoskeletal assessment

Pain, Paralysis, Parasthesias, Pulselessness, Pallor, and Pressure.

Neurovascular Compromise

The loss of the nerve supply, blood supply, or both to a region of the body, typically distal to a site of injury; characterized by alterations in sensation, including numbness and tingling, or by a loss or decrease of motor function; vascular compromise is indicated by weak or absent pulses, poor skin color, and cool skin.

in a dislocation

a bone is totally displaced from the joint -dislocations occur when a body part moves beyond its normal ROM

boxers fracture is

a fracture of the neck of the fifth metacarpal it commonly occurs after punching a hard object such as a wall or a door

assessment of nursemaids

a palpable deformity may be present at the elbow from the prominence of the olecranon

signs of an arterial injury include

a pulsatile expanding hematoma diminished distal pulses a palpable thrill over the site of injury

metacarpal shaft

fractures of the metacarpals may result from a crush injury or from direct trauma

management for compartment syndrome

position extremity at heart level ( not above) coldpacks give a bolus of saline to help the kidneys flush out toxins from the resulting rhabdomyolysis

the classic sign of a radial nerve injury is

an inability to extend the wrist termed wrist drop

splinting a midshaft humerous fracture

apply a rigid splint that extends from the axilla to the elbow

sprains

are injuries in which ligaments are stretched or torn -usually result from a sudden movement of a joint beyond its normal ROM

shoulder girdle

base of the upper arm it consists of a scapula and clavicle

crush syndrome will lead to rhabdomyolysis

because of tissue death which results in the release of harmful products

greenstick fracture

bending and incomplete break of a bone; most often seen in children

comminuted fracture

bone breaks into many fragments

incomplete fracture

break through one cortex

complete fracture

breaks through both cortices

how are dislocated bones held in there abnormal place

by muscle spasms

if the brachial artery is compromised

compartment syndrome could develop

splinting a injury in an anatomic position can help relieve pressure on the

damaged nerve

what is a risk factor for deleloping a stress fractue

endocrine dysfunction

to identify the anatomic snuffbox on yourself

extend your thumb twotendons will be visible at the base of the thumb on the radial aspect of the wrist

there are two factors that contribute to compartment syndrome

external like bangages and splints applied to tight and internal like bleeding and swelling

groups of muscles are surrounded by an inelastic membrane called

fascia; thus muscles are confined to an enclosed space or compartment that can accommodate only a limited amount of swelling

fat embolism

fat droplets become lodged in the vasculature of the lungs symptoms begin within 12 to 72 hours of injury symptoms: tachy, SOB, congestion fever PETECHIAE change in mental staus and organ dysfunction

pts with long bone fractures are at risk for developing a

fat embolism

pelvic gridle

forms the base of the torso and connects the axial skeleton with the lower extremities

Colles fracture

fracture of the distal radius at the wrist

when fractues heal osteoblast play a role by invading the fracture site and allowing a callus to form

in this process new bone called osteoid is built around the fracture site a step in the process of bone remodeling

luxation

is a complete dislocation

a strain (Pulled muscle or tendon)

is an injury to a muscle and or tendon that results from a violent muscle contraction or from excessive stretching

the scaphoid also called the carpal navicular

is located just distal to the radius

what is the primary toxins released after crush injury

lactate, potassium and myoglobin there release can result in decreased blood pH (acidosis)

in women bones decrease in density after age

menopause is reached

in most cases the clavical fractures in the

middle third of the bone typically from a fall onto an outstretched hand

shoulder dislocation

most are anterior dislocations

a dislocation is considered an urgent injury becasue of its potential to cause

neurovascular compromise distal to the site of injury; if the dislocated bone presses on a nerve the patient may experience numbness or weakness distally

oblique fracture

occurs at an angle across the bone

crush syndrome

occurs because of prolonged compression force that impairs muscle metabolism and circulation

buckle fracture

occurs in the metaphysis of long bones in response to excessive compression loading on onee side of the bone the compressed cortex buckles and the opposite cortex is pulled away from the physis

transverse fracture

occurs straight across the bone

indirect injury

occurs when a force strikes one region of the body and is transferred to an area away from the point of impact

stress fracture

occurs when the muscle develops faster than the bone and places exaggerated stress on the less developed bone

anterior posterior compression pelvic ring disruptions

open book pelvic fracture: the force of the impact compresses the pelvis in the anterior to posterior directioin causing the pubic symphysis and posterior supporting ligaments to be disrupted and tear apart

cortices

outer layers of bone

the classic finding associated with a scaphoid fracture is

pain and tenderness in the anatomic snuffobx

assessment tools for compartment syndrome

passive stretching of an ischemic muscle will result in sever pian so have them felx and extend the great toe and dosiflex and plantar flex same with finger and hand flex and extention

potential blood loss from fracture sites

pelvis: 1500-3000, femur: 1000-1500, tib or fib ankle elbow: 250-500